Small cell carcinoma of the vagina

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Dear OncoLink "Ask The Experts," My wife was diagnosed with small cell carcinoma of the vagina in early 2001. The tumor was surgically removed and she underwent radiotherapy in combination with cisplatnin. After the radiotherapy was complete she had six cycles of Carboplatnin and VP-16. In March of this year the cancer reappeared with four tumors in her lungs. She underwent radiotherapy to her lungs in combination with 5FU. After radiotherapy was complete she was given Taxol. Last week the results of her latest CT scan showed that her disease had progressed and she was being switched to Gemzar®. Are there any advanced treatments? Are the doctors going in the right direction?

Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:

Small cell carcinoma of the vagina is an exceedingly rare tumor, with fewer than 25 cases reported in the medical literature. Because it is so rare, there is no firm consensus regarding treatment. Patients are usually treated with concurrent chemotherapy and radiation with or without surgery, depending on the location. Despite aggressive treatment, many patients have tumor recurrence--often in sites outside of the pelvis. Chemotherapy with platinum and VP-16 has been used for patients with small cell tumors of the lung with some success. However, after the disease has progressed through multiple chemotherapy regimens, I do not think that anyone can say with certainty what the next best treatment is, given the rarity of this type of cancer. If your wife does not experience any benefit from the Gemzar chemotherapy, you may consider seeking treatment at a center that offers phase I clinical trials of investigational chemotherapies.